成人急性肾损伤患者连续性肾脏替代治疗管理的最佳证据总结

Summary of best evidence for the management of continuous renal replacement therapy in adults with acute kidney injury

目的评价并总结对急性肾损伤患者行连续性肾脏替代治疗的最佳证据,为临床实践提供循证依据。方法 计算机检索英国国家卫生与临床优化研究所网站、美国国立指南网、美国肾脏病学会、中华医学会肾脏病学分会、Cochrane Library、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、UpToDate、BMJ Best Practice、PubMed、万方数据库、维普网、中国知网等专业协会网站和数据库中关于成人急性肾损伤患者连续性肾脏替代治疗的相关文献。检索时限为建库至2023年2月。结果 共纳入15篇文献,包括指南2篇、专家共识5篇、系统评价和Meta分析3篇、证据总结1篇、临床决策4篇,从患者评估、适应证和时机选择、连续性肾脏替代治疗方案、过程监护及并发症预防、营养支持5个方面最终形成了29条最佳证据。结论 该研究对成人急性肾损伤连续性肾脏替代治疗的最佳证据进行总结,可为临床实践提供参考,同时也应结合患者状况和我国当前医疗资源来制订个体化的治疗方案,以改善患者的临床结局。

Objective To evaluate and summarize the best evidence for the management of continuous renal replacerment therapy in patients with acute kidney injury and to provide evidence for clinical practice.Methods We searched the National Institute for Health and Clinical Excellence website,National Guidelines Network,American Society of Nephrology,Chinese Society of Nephrology,Cochrane Library,Joanna Briggs Institute Evidence-Based Health Care Database,Up To Date,BMJ Best Practice,PubMed,W anfang,VIP,CNKI,and other professional societies websites and databases for relevant literature on continuous renal replacement therapy in adults with acute kidney injury.The retrieval period was from the establishment of the database to February 2023.Results A total of 15 articles were included,including 2 guidelines,5 expert consensus articles,3 systematic reviews and Meta-analyses,1 evidence summary,and 4 clinical decisions,forming 29 best evidence articles in 5 aspects:patient assessment,indications and timing,continuous.renal replacement therapy program,process monitoring and complication prevention,and nutritional support.Conclusion The best evidence for continuous renal replacement therapy in adults with acute kidney injury was summarized in this study,which can provide a reference for clinical practice.The evidence should be combined with patient status and our current medical resources to develop individualized treatment plans to improve clinical outcomes for patients.